Abstract
Despite the proven effectiveness of selective serotonin reuptake inhibitors (SSRIs) and cognitive- behavioral therapy (CBT) in the treatment of obsessive- compulsive disorder (OCD , about half of patients show inadequate responses to the treatment strategies. For poor responders to SSRIs, in particular, additional pharmacologic treatment strategies such as combination drug treatment strategies have been investigated, and second- generation atypical antipsychotic drugs have been proven effective in the augmentation of SSRIs. However, even when these best available treatments are applied, a number of OCD patients remain severely affected and experience treatment - refractory OCD. Moreover, some research regarding long- term course and outcome of OCD patients has revealed that the probability of remission or partial remission still remains insufficient at the level of 40-60%, with substantial probabilities of relapse (15-48%).
For such OCD patients, re- evaluation of clinical features along with ongoing treatments is needed to optimize the standard treatment strategies for OCD. Further devised and more intensive treatment strategies such as cognitive therapy or inpatient treatment may also be applied after re- evaluating psychopathological, neurobiological and environmental factors associated with the treatment- refractory in each individual. In addition, it seems important to determine the definition of “treatment- refractory” more distinctly and strictly for further application of more invasive options such as TMS or DBS.
